LWPES: Diet Deficits Mislabeled as Failure to Thrive

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that although children with symptoms of failure to thrive are often subjected to a battery of diagnostic tests, in most cases they suffer from inadequate caloric intake.

Note that only 1.5% were ultimately found to have growth hormone deficiency.

DENVER -- Children with symptoms of failure to thrive are often subjected to a battery of tests to pinpoint the problem, but, in most cases, they suffer from inadequate caloric intake researchers found, according to a study presented.

In a retrospective chart review of 330 children identified as failing to thrive, two-thirds of them (217) were just not eating properly, Maj. Robert Cornfeld, MD, and colleagues reported at the Lawson Wilkins Pediatric Endocrine Society meeting here.

"This study emphasizes that when we have cases of failure to thrive, we should first make sure that these children are fed properly," Cornfeld said.

Cornfeld and colleagues looked at the charts for 185 boys and 145 girls, who were diagnosed with failure to thrive, between 2002 and 2009. This subject arm was compared with a control population of 96 boys and 103 girls.

Of the 330 children, only five (about 1.5%) were ultimately found to have growth hormone deficiency and all of them were placed on growth hormone therapy, Cornfeld said. The most common etiologies for failure to thrive were as follows:

Inadequate caloric intake in 60% of the cases

Gastroesophageal reflux disease in 6% of the cases

Hypothyroidism in 6% of the cases

Eosinophilic esophagitis in 4% of the cases

Another 22 children who were initially thought to be failing to thrive were actually growing at their genetic potential. There were a dozen cases where the etiology of the failure to thrive was not known.

The authors also noted some of the characteristics of children who were at risk for failure to thrive including developmental delays, a history of postnatal complications, and premature birth. When comparing the study arm with the control arm, the researchers found the following:

Developmental delays: 33% versus 6% (P<0.001)

Premature birth: 15% versus 3% (P<0.001)

Postnatal complications: 24% versus 3% (P<0.001)

At least one lab study was performed in 90% of subjects, but this testing only yielded diagnostic results in 6% of the cases, the authors said.

"Exhaustive laboratory evaluation is expensive and frequently low yield," Cornfeld said, adding that the average evaluation cost per patient was $3,003. "The expense of this evaluation is exclusive of the costs to the family such as time spent while undergoing the evaluation and the psychological burden felt by parents when told their child is growing poorly."

While failure to thrive is a major concern for parents, major disorders, such as growth hormone deficiency, are rare, commented Ben Sanders, MD, a general pediatrician based in Philadelphia.

"If children don't eat well, they don't grow," Sanders told MedPage Today. "But rarely are there organic reasons – growth hormone deficiency – for failure to thrive. In this study, there were five children with growth hormone deficiency and 20 with hypothyroidism. In general, hypothyroidism should be picked up with neonatal testing, but the tests aren't perfect."